Independent Quality Assessment Research Articles

Utility of ureteral diameter ratio for clinical decision-making in children with vesicoureteral reflux: a systematic review and meta analysis.

The aim of this study was to investigate the utility of ureteral diameter ratio (UDR) as a tool to prognosticate and manage vesicoureteral reflux (VUR). Four scientific databases (PubMed, EMBASE, Web of Science, and Scopus) were systematically searched. Inclusion criteria were all studies in which UDR was used in prognostication and/or management of VUR. An independent assessment of the methodological quality was performed by two authors using the Newcastle Ottawa Quality scale. The statistical analysis was performed using a random-effects model. Thirteen studies (all retrospective) were included in this review. Pooling the data demonstrated a significantly lower UDR in the spontaneous resolution vs. persistence of VUR group (p = 0.001). Also, the pooled data showed significantly higher values of UDR in the breakthrough UTI group (p < 0.00001), those requiring operative intervention (p = 0.03), and those with persistence of VUR after endoscopic treatment (p < 0.0001). The estimated heterogeneity for two outcomes, i.e., spontaneous resolution and requirement of operative intervention in VUR were substantial and statistically significant. All except one of the included studies were of good methodological quality. However, further studies are required to identify the cut-off values for these respective outcomes.

Health Care Professionals' Experience of Using AI: Systematic Review With Narrative Synthesis.

There has been a substantial increase in the development of artificial intelligence (AI) tools for clinical decision support. Historically, these were mostly knowledge-based systems, but recent advances include non-knowledge-based systems using some form of machine learning. The ability of health care professionals to trust technology and understand how it benefits patients or improves care delivery is known to be important for their adoption of that technology. For non-knowledge-based AI tools for clinical decision support, these issues are poorly understood. The aim of this study is to qualitatively synthesize evidence on the experiences of health care professionals in routinely using non-knowledge-based AI tools to support their clinical decision-making. In June 2023, we searched 4 electronic databases, MEDLINE, Embase, CINAHL, and Web of Science, with no language or date limit. We also contacted relevant experts and searched reference lists of the included studies. We included studies of any design that reported the experiences of health care professionals using non-knowledge-based systems for clinical decision support in their work settings. We completed double independent quality assessment for all included studies using the Mixed Methods Appraisal Tool. We used a theoretically informed thematic approach to synthesize the findings. After screening 7552 titles and 182 full-text articles, we included 25 studies conducted in 9 different countries. Most of the included studies were qualitative (n=13), and the remaining were quantitative (n=9) and mixed methods (n=3). Overall, we identified 7 themes: health care professionals' understanding of AI applications, level of trust and confidence in AI tools, judging the value added by AI, data availability and limitations of AI, time and competing priorities, concern about governance, and collaboration to facilitate the implementation and use of AI. The most frequently occurring are the first 3 themes. For example, many studies reported that health care professionals were concerned about not understanding the AI outputs or the rationale behind them. There were issues with confidence in the accuracy of the AI applications and their recommendations. Some health care professionals believed that AI provided added value and improved decision-making, and some reported that it only served as a confirmation of their clinical judgment, while others did not find it useful at all. Our review identified several important issues documented in various studies on health care professionals' use of AI tools in real-world health care settings. Opinions of health care professionals regarding the added value of AI tools for supporting clinical decision-making varied widely, and many professionals had concerns about their understanding of and trust in this technology. The findings of this review emphasize the need for concerted efforts to optimize the integration of AI tools in real-world health care settings. PROSPERO CRD42022336359; https://tinyurl.com/2yunvkmb.

Prediction and policy: Do empirical gross calorific value prediction help reduce coal testing overload?

The gross calorific value (GCV) of coal is pivotal in shaping policies across various sectors of the Indian economy. It plays a crucial role in classification and valuation of coal and is a major factor in determining electricity tariffs charged by thermal power plants. With coal production escalating year-on-year to meet India's increasing electricity demand, there is significant rise in coal testing activities along the pit-to-power supply chain at multiple points and by multiple testing agencies often driven by sector-specific policy requirements. While laboratory testing accurately determines GCV, it is costly and time-consuming due to the reliance on expensive equipment and skilled personnel. Global researchers have previously devised a plethora of empirical formulae predicting GCV based on its correlations with easy-to-measure properties like moisture and ash content. However, the applicability and utility of these formulae to the prevalent policy matrix of coal and power sector remain to be explored. The introduction of independent third-party assessment of coal quality by Coal India Limited in 2016 has generated a vast dataset of coal sample-test results, offering an opportunity to reassess existing empirical formulae, test their alignment with existing policies, and explore possibility of a unified, region-neutral formula for rapid GCV prediction with a special focus on alleviating the current overload in coal testing.

The effectiveness of parenteral agents to mitigate relapses after severe acute migraine headache presentations: A systematic review and network analysis.

To compare the effectiveness of parenteral agents to reduce relapse in patients with acute migraine and identify factors that predict relapse. Following discharge from emergency settings, many patients with acute migraine will experience a relapse in pain; severe relapses may result in re-visits to emergency settings. A comprehensive literature search, updated to 2023, was conducted to identify randomized controlled trials assessing the effectiveness of parenteral agents on relapse outcomes in patients with acute migraine discharged from emergency settings. Two independent reviewers completed study selection, quality assessment, and data extraction. A traditional meta-analysis compared parenteral corticosteroids to placebo; a frequentist network analysis assessed direct and indirect comparisons. Results are reported as risk ratios (RRs) and 95% confidence intervals (CIs). The review protocol was registered with the International Prospective Register of Systematic Reviews (identifier: CRD42018099493). From 8949 citations, a total of 53 unique studies were included involving 6167 patients. Most studies had a high or unclear risk of bias. Corticosteroids significantly reduced relapses compared to placebo (RR 0.67, 95% CI 0.52-0.88; I2 = 0%). Patients receiving lidocaine (RR 0.10, 95% CI 0.01-0.82), sedatives/hypnotics (RR 0.33, 95% CI 0.14-0.75), ergot agents (RR 0.44, 95% CI 0.25-0.75), neuroleptics (RR 0.47, 95% CI 0.31-0.71), opioids (RR 0.58; 95% CI 0.35-0.94), or corticosteroids (RR 0.64, 95% CI 0.47-0.86) were significantly less likely to relapse. Lidocaine (RR 0.09, 95% CI 0.01-0.71), combination therapy (RR 0.12, 95% CI 0.02-0.74), or adding corticosteroids (RR 0.61, 95% CI 0.44-0.84) were more likely to reduce severe relapses. Longer duration of headache and residual pain at discharge were significantly associated with higher relapses. Corticosteroids remain the recommended first-line option to reduce relapse outcomes. Some parenteral agents typically provided for pain relief including ergot agents, neuroleptics, or combination therapy may effectively reduce relapse; however, opioids are not recommended due to safety concerns. Additional research is needed for some lesser studied, albeit promising, agents including lidocaine and propofol. Effective pain control in emergency settings prior to discharge and duration of headache may play a role in the success of such treatments and further investigations could provide further insight regarding how and why some parenteral agents are effective in mitigating relapse events.

Quality and Readability of Noise-Induced Hearing Loss Prevention-Related Websites.

This cross-sectional website analysis aimed to determine the readability and quality of English and Spanish websites pertaining to the prevention of noise-induced hearing loss. Cross-sectional website analysis. Various online search engines. We queried four popular search engines using the term "noise-induced hearing loss prevention" to reveal the top 50 English and top 50 Spanish websites for data collection. Websites meeting inclusion criteria were stratified based on the presence of a Health on the Net Code certificate (independent assessment of honesty, reliability, and quality). Websites were then independently reviewed by experts using the DISCERN criteria in order to assess information quality. Readability was calculated using the Flesch reading ease score for English and the Fernandez-Huerta formula for Spanish websites. Thirty-six English websites and 32 Spanish websites met the inclusion criteria. English websites had significantly lower readability (average = 56.34, SD = 11.17) compared to Spanish websites (average = 61.88, SD = 5.33) (P < .05). Spanish websites (average = 37, SD = 8.47) were also of significantly higher quality than English websites (average = 25.13, SD = 10.11). This study emphasizes the importance of providing quality and readable materials to patients seeking information about noise-induced hearing loss prevention. All of the English and Spanish websites reviewed were written at a level higher than the American Medical Association-recommended sixth-grade reading level. The study also highlights the need for evidence-based information online provided by experts in our field.

Benchmarking of AlphaFold2 accuracy self-estimates as indicators of empirical model quality and ranking: a comparison with independent model quality assessment programmes.

Despite an increase in protein modelling accuracy following the development of AlphaFold2, there remains an accuracy gap between predicted and observed model quality assessment (MQA) scores. In CASP15, variations in AlphaFold2 model accuracy prediction were noticed for quaternary models of very similar observed quality. In this study, we compare plDDT and pTM to their observed counterparts the local distance difference test (lDDT) and TM-score for both tertiary and quaternary models to examine whether reliability is retained across the scoring range under normal modelling conditions and in situations where AlphaFold2 functionality is customized. We also explore plDDT and pTM ranking accuracy in comparison with the published independent MQA programmes ModFOLD9 and ModFOLDdock. plDDT was found to be an accurate descriptor of tertiary model quality compared to observed lDDT-Cα scores (Pearson r = 0.97), and achieved a ranking agreement true positive rate (TPR) of 0.34 with observed scores, which ModFOLD9 could not improve. However, quaternary structure accuracy was reduced (plDDT r = 0.67, pTM r = 0.70) and significant overprediction was seen with both scores for some lower quality models. Additionally, ModFOLDdock was able to improve upon AF2-Multimer model ranking compared to TM-score (TPR 0.34) and oligo-lDDT score (TPR 0.43). Finally, evidence is presented for increased variability in plDDT and pTM when using custom template recycling, which is more pronounced for quaternary structures. The ModFOLD9 and ModFOLDdock quality assessment servers are available at https://www.reading.ac.uk/bioinf/ModFOLD/ and https://www.reading.ac.uk/bioinf/ModFOLDdock/, respectively. A docker image is available at https://hub.docker.com/r/mcguffin/multifold.

The Impact of Pain Education Interventions for Cancer Survivors and Caregivers: A Systematic Review with Meta-Analysis.

Cancer-related pain is a global health-related problem associated with functional impairment, anxiety, depression, and reduced quality of life. The use of educational interventions for patients and their caregivers has been proposed as a promising tool for overcoming pain in cancer. The aim of this study was to summarize by means of a standardized methodological systematic revision the actual pain education intervention used in cancer patients and their caregivers and to analyze its effects on pain. A search was conducted through PubMed, Web of Science, Scopus and Cinhal from their inception to September 2022. Randomized controlled trials which included pain education interventions were identified. Two reviewers performed independent data extraction and methodologic quality assessments of these studies. A total of seven studies was included in the study. The meta-analysis showed that pain education interventions have a significant effect on the worst pain; however, there was no effect on average pain. Pain education interventions addressed to patients and their caregivers could have positive effects on cancer-related pain. It is recommended that a minimum of three sessions of about one hour's duration be held once a week. Further research needs to be carried out and analyzed on the effects over the long term. Pain education interventions show positive results in improving pain in cancer patients regardless of etiology or extent of the cancer. Studies with better methodological quality should be carried out to address specific components related to education interventions.

Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes: Systematic Review and Meta-Analysis

Acute aortic syndrome is a life-threatening emergency condition. Previous systematic reviews of D-dimer diagnostic accuracy for acute aortic syndrome have been contradictory and based on limited data, but recently published studies offer potential for a more definitive overview. We aimed to perform a systematic review and meta-analysis to determine the diagnostic accuracy of D-dimer for diagnosing acute aortic syndrome. We searched MEDLINE, EMBASE, and the Cochrane Library from inception to February 2024. Additionally, the reference lists of included studies and other systematic reviews were thoroughly searched. All diagnostic cohort studies (prospective or retrospective) that assessed the use of D-dimer for diagnosing acute aortic syndrome compared with a reference standard test (eg, computed tomographic angiography (CTA), ECG-gated CTA, echocardiography, magnetic resonance angiography, operation, or autopsy) were included. Two independent reviewers completed study selection, data extractions and quality assessment using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Data were synthesized using a bivariate meta-analysis model. Of 2017 potentially relevant citations, 25 cohort studies met the inclusion criteria, and 18 reporting the 500 ng/mL threshold were included in the primary meta-analysis. Risk of bias domains were mostly unclear due to limited study reporting. The summary sensitivity was 96.5% (95% credible interval [CrI] 94.8% to 98%) and summary specificity was 56.2% (95% CrI, 48.3% to 63.9%). Study specificity varied markedly from 33% to 86%, indicating substantial heterogeneity. Sensitivity analysis including the 7 studies reporting other thresholds showed summary sensitivity of 95.7% (95% CrI, 93.2% to 97.5%) and summary specificity of 57.5% (95% CrI, 50.1% to 64.6%). D-dimer concentration has high sensitivity (96.5%) and moderate specificity (56.2%) for acute aortic syndrome, with some uncertainty around estimates due to risk of bias and heterogeneity. Previous meta-analysis reporting higher specificity may be explained by inclusion of case-control studies that may overestimate accuracy.

Effects of calcitonin on lumbar spinal stenosis.

Systematic review and meta-analysis. There is some controversy about the effects of calcitonin (CT) on lumbar spinal stenosis (LSS). This systematic review and meta-analysis is to assess the strength of the evidence supporting the use of CT in the treatment of patients with LSS. We performed an electronic search depicting randomized controlled trials (RCTs) through 4 databases from the date of database creation to January 2023. 3 different researchers conducted independent literature screening, data extractions, and quality assessments. The outcome measures included visual analogue scale (VAS), walking distance, and oswestry disability index (ODI). Meta-analysis and trial sequence analysis (TSA) were carried out using RevMan 5.4, Stata 16.0, and TSA 0.9. GRADE 3.6 was used to evaluate the evidence quality. We accepted 9 studies with 496 participants. The meta-analysis revealed that CT offered no significant improvement in VAS, walking distance, or ODI in patients with LSS. There is no evidence that CT has a benefit in patients with LSS, either alone or in combination with other treatments, or depending on the route of administration, according to the systematic review and meta-analysis of relevant RCTs.

Prevalence of HIV Self-Testing Among Men Who Have Sex With Men: Evidence Synthesis by Systematic Review and Meta-Analysis.

HIV self-testing (HIVST) plays a significant role in addressing the health care needs of high-risk populations, particularly men who have sex with men (MSM). The present systematic review and meta-analysis provide an assessment of the prevalence of HIVST among MSM within the last 5 years. Seven databases (PubMed, Web of Science, Cochrane, Scopus, EMBASE, ProQuest, and EBSCOhost) were searched systematically from January 1, 2018 to March 10, 2023. After an independent search and quality assessment, the pooled prevalence was calculated using a random-effects model. Eight relevant studies were finally included in our study from an initial pool of 288 articles identified through a systematic search. Our meta-analysis revealed that the pooled prevalence of HIVST among MSM is 8% (95% CI: 5%-14%). Significant heterogeneity was noticed among the studies, with an I2 value of 99% and a 95% prediction interval of 3% to 11%. Geography emerged as a significant moderator of this heterogeneity (p < .001). Specifically, studies from China reported a notably higher prevalence of 20% (15%-26%), while other countries reported a lower prevalence of 5% (3%-6%). A symmetrical Doi plot with a Luis-Furuya-Kanamori (LFK) index of -0.57 indicated no publication bias. HIVST has a low take-up among MSM globally. Factors leading to variation in HIVST need to be studied. The coordinated efforts of policymakers, health care providers, and affected communities are required in HIVST promotion.

Effects of continuing nursing intervention on high‐risk patients with diabetic foot ulcers: A meta‐analysis

AbstractA comprehensive meta‐analysis was conducted to evaluate the impact of continuous nursing interventions on patients with high‐risk diabetic foot (DF). We systematically searched electronic databases including PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang for randomized controlled trials (RCTs), from database inception to October 2023, pertaining to continuous nursing interventions in high‐risk DF patients. Independent literature screening, data extraction and quality assessment were performed by two researchers. Data analysis was executed using Stata 17.0 software. Overall, 18 RCTs involving 1450 high‐risk DF patients were included. The analysis revealed that continuous nursing interventions significantly reduced levels of fasting blood glucose (standardized mean difference [SMD] = −1.02, 95% confidence interval [CI]: −1.29 to −0.76, p &lt; 0.001), 2‐h postprandial blood glucose (SMD = −1.76, 95%CI: −2.23 to −1.29, p &lt; 0.001) and glycated haemoglobin levels (SMD = −1.05, 95%CI: −1.40 to −0.70, p &lt; 0.001) in high‐risk DF patients. Furthermore, there was a significant reduction in the incidence of DF (odds ratio [OR] = 0.22, 95%CI: 0.14–0.33, p &lt; 0.001). This study demonstrates that continuous nursing interventions are effective in controlling glycaemic indices (fasting blood glucose, 2‐h postprandial blood glucose and glycated haemoglobin) and reducing the incidence of DF in high‐risk patients. These interventions contribute to stabilizing the patients' condition and optimizing their prognosis.

The Effect of Shoulder Immobilization Position on Outcomes Following Rotator Cuff Repair: A Scoping Review

Introduction: There has been growing interest in determining the influence of post-operative immobilization posture and rehabilitation protocol on healing rates and clinical outcomes. Current consensus calls for the use of an immobilization device post-operatively, which commonly comes in the form of a standard sling or an abduction brace with the arm positioned in varying degrees of abduction. There is a lack of high-level evidence in the literature to recommend one type of immobilization device or arm position over another. Objectives: This study aimed to summarize the current clinical and biomechanical evidence for the optimal postoperative positioning and bracing of the arm following arthroscopic rotator cuff repair. Methods: A comprehensive search of the electronic databases EMBASE, MEDLINE, and PubMed was performed using a combination of the following keywords and medical subject heading (MeSH) terms: ‘arthroscopic’, ‘rotator cuff repair’, ‘sling’, ‘brace’ and ‘immobilization’. This systematic review was conducted following the Preferred Reporting for Systematic Reviews and Meta-analysis (PRIMSA) guidelines. Two reviewers performed an independent assessment of the methodological quality of each eligible clinical study using the Methodological Index for Non-Randomized Studies (MINORS). Results: Based on current biomechanical evidence, placement of the arm into an abducted position following rotator cuff repair was found to be favorable. An abduction angle of 30° was associated with lower strain on the repair while maintaining appropriate contact pressure at the footprint. However, the use of an abduction brace did not result in a clinically significant improvement in long-term PROM, ROM, and re-tear rates when compared to a traditional sling in clinical studies. Conclusion: Despite observing favorable outcomes with abduction bracing after rotator cuff repair in biomechanical studies these findings were not reproduced in clinical studies. However, current clinical studies are comprised of small sample sizes, varying tear sizes, and significant heterogeneity in both, the degree of abduction and forearm rotation. Future studies should be directed towards prospectively investigating the effect of immobilization position among patients with similar rotator cuff tear sizes.

Prevalence and risk factors for diabetic retinopathy in Saudi Arabia: systematic review study

This systematic review aimed to thoroughly examine the prevalence and risk factors linked with diabetic retinopathy (DR) – a severe complication of diabetes mellitus (DM) – among individuals with diabetes in the Kingdom of Saudi Arabia (KSA). A systematic search of published studies was conducted in PubMed, Google Scholar, Cochrane, and Web of Science databases for studies published between the years 2015-2023. The articles were screened based on well-defined inclusion and exclusion criteria, ensuring that only the most relevant and high-quality studies were included. Additionally, reviewers performed independent data extraction and quality assessment, providing a robust and reliable foundation for the study findings. Thirteen studies satisfied the inclusion criteria, comprising a prospective, and twelve observational cross-sectional studies. Prevalence varied widely across the studies, ranging from 14.9% to 45.2% in individuals with established DM and 3.3% to 6.25% in newly diagnosed type 2 DM. Risk factors identified included old age, poor glycemic control, longevity of DM, smoking, gender, overweight and obesity, hypertension, presence of microvascular and macrovascular diabetic complications, type 1 DM, hyperlipidemia, and insulin use. Timely detection and management of these factors, along with regular screening for DR, are imperative to mitigate its burden on visual health and the overall healthcare system. Further research focusing on interventions to address modifiable risk factors and improve DR outcomes in the KSA population is warranted.

Efficacy of acupuncture combined with mirror therapy in the treatment of post-stroke limb movement disorders: a systematic review and meta-analysis of randomised controlled trials.

To investigate whether the combination of acupuncture and mirror therapy can improve motor impairment in stroke patients. A systematic review and meta-analysis of randomised controlled trials. CNKI, Wanfang, PubMed, Embase, Vip, web of since, Cochrane database and CBM database. The included randomized controlled trials compared the efficacy of acupuncture therapy (AT) combined with mirror therapy (MT) against AT, MT, and conventional rehabilitation therapy on limb motor impairment in stroke patients, with independent data extraction and study quality assessment conducted. A META analysis using fixed-effect and random-effect models was performed to calculate the mean difference (MD) in motor scores and the Total effective rate RR (Risk ratio) between the AT combined with MT group and the control group. The Fugl-Meyer Assessment (FMA) for motor function includes the FMA-T (total FMA), FMA-UE (upper extremity FMA), and FMA-L (lower extremity FMA). A total of 42 randomized controlled trials were included, involving 3,340 patients with post-stroke motor impairment. AT combined with MT was more favorable for FMA-UE (mean difference [MD] = 6.67, 95% CI [5.60-7.93], Z = 11.42, P < 0.0001), FMA-L [MD = 3.37, 95% CI (2.99-3.76), Z = 17.31, P < 0.001], and FMA-T [MD = 6.84, 95% CI (5.92-7.77), Z = 14.48, P < 0.001]. The combined AT and MT treatment was more favorable for the Modified Barthel Index (MBI) score in post-stroke motor impairment [MD = 10.82, 95% CI (8.52-13.12), Z = 9.22, P < 0.001]. AT combined with MT was more favorable for the Modified Ashworth Scale (MAS) [MD = -0.34, 95% CI (-0.66 to -0.03), Z = 14.48, P < 0.001]. AT combined with MT was more favorable for the Total effective rate in treating post-stroke motor impairment (relative risk = 1.27, 95% confidence interval [CI] [1.19-1.37], Z = 6.54, P < 0.001). AT combined with MT can effectively improve patients' motor function and daily living abilities. PROSPERO, identifier, CRD42024559992.

Evidence synthesis on coercion in mental health: An umbrella review.

Coercion in mental healthcare is ubiquitous and affects the physical health, recovery and psychological and emotional well-being of those who experience it. Numerous studies have explored different issues related to coercion, and the present umbrella review aims to gather, evaluate and synthesise the evidence found across systematic reviews. The protocol, registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42020196713), included 46 systematic reviews and meta-analyses of primary studies whose main theme was coercion and which were obtained from databases (Medline/PubMed, PsycINFO, EMBASE and CINAHL) and repositories of systematic reviews following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. All the reviews were subjected to independent assessment of quality and risk of bias and were grouped in two categories: (1) evidence on specific coercive measures (including Community Treatment Orders, forced treatment, involuntary admissions, seclusion and restriction and informal coercion), taking into account their prevalence, related factors, effectiveness, harmful effects and alternatives to reduce their use; and (2) experiences, perceptions and attitudes concerning coercion of professionals, mental health service users and their caregivers or relatives. This umbrella review can be useful to professionals and users in addressing the wide variety of aspects encompassed by coercion and the implications for professionals' daily clinical practice in mental health units. This research received funding from two competitive calls.

To investigate the association of serum osteocalcin with cognitive functional status in patients with type 2 diabetes: A systematic review with meta-analysis.

To systematically evaluate the correlation between serum osteocalcin levels and cognitive function status in type 2 diabetes mellitus (T2D) patients. This review was conducted according to the PRISMA guidelines, and was developed and submitted to PROSPERO (CRD42022339295). We comprehensively searched PubMed, EMBASE, Web of Science, Scopus, ProQuest, and Chinese Databases (China National Knowledge Infrastructure, Wan Fang, Chinese Science and Technology Periodical Database, and China Biology Medicine) up to 1 June 2023. 3 investigators performed independent literature screening and data extraction of the included literature, and 2 investigators performed an independent quality assessment of case-control studies using the Newcastle-Ottawa-Scale tool. Data analysis was performed using Review Manager 5.4 software. For continuous various outcomes, mean difference (MD) or standardized MD with 95% confidence intervals (CIs) was applied for assessment by fixed-effect or random-effect model analysis. The heterogeneity test was performed by the Q statistic and quantified using I2, and publication bias was evaluated using a funnel plot. 9 studies with T2D were included (a total of 1310 subjects). Meta-analysis results indicated that cognitive function was more impaired in patients with lower serum osteocalcin levels [MD = 9.91, 95% CI (8.93, -10.89), I2 = 0%]. Serum osteocalcin levels were also significantly different between the 2 groups of T2D patients based on the degree of cognitive impairment [MD = -0.93, 95% CI (-1.09, -0.78), I2 = 41%]. It summarized the statistical correlation between serum osteocalcin and cognitive function scores in patients with T2D at r = 0.43 [summary Fisher's Z = 0.46, 95% CI (0.39, -0.50), I2 = 41%). After sensitivity analysis, the heterogeneity I2 decreased to 0%, indicating that the results of the meta-analysis are more reliable. Based on a meta-analysis of included studies, we concluded that there is a moderately strong positive correlation between serum osteocalcin levels and patients' cognitive function in T2D. An intervention to increase serum osteocalcin levels can contribute to delaying and improving cognitive decline in patients with T2D.

UK Valuation of EQ-5D-5L, a Generic Measure of Health-Related Quality of Life: A Study Protocol

ObjectivesA high-quality and widely accepted UK EQ-5D-5L value set is urgently required to enable the latest version of EQ-5D scored using recent UK public preferences to inform policy including health technology assessments submitted to the National Institute for Health and Care Excellence. This article outlines the study protocol for the generation of a new EQ-5D-5L UK value set. MethodsTwelve hundred interviews will be undertaken using the composite time trade-off elicitation technique for 102 health states (86 from the international EQ-5D-5L valuation protocol, plus 16 with best predictive performance in an extended design used in the Native American EQ-5D-5L valuation). The sample will be UK adults (age ≥18 years) proportionately representative across England, Wales, Scotland, and Northern Ireland, representative for age, sex, ethnicity, and socioeconomic group, with inclusion of participants with/without health problems. Participants will choose to be interviewed via videoconference (by Zoom) or in-person in a central venue. Data quality will be rigorously assessed. ResultsThe value set will be generated using tobit random effects and heteroscedastic tobit models (with censoring at −1) using all data, excluding time trade-off values highlighted by participants as ones they would reconsider and data from interviewers failing protocol compliance. Quality and acceptance will be achieved by public involvement, regular Steering Group meetings, independent assessment of data quality at 4 time points, and final endorsement of data and analyses. ConclusionThis study will produce a UK value set for the EQ-5D-5L for use in prospective and retrospective data sets containing EQ-5D-5L data.

Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and Meta-Analysis

Associations between tobacco use and poor TB treatment outcomes are well documented. However, for important outcomes such as TB recurrence or relapse and mortality during treatment, as well as for associations with smokeless tobacco (ST), the evidence is not summarized systematically. Is tobacco use associated with risk of poor treatment outcomes among people with TB? The MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature databases were searched on November 22, 2021. Epidemiologic studies reporting associations between tobacco use and at least one TB treatment outcome were eligible. Independent double-screening, extractions, and quality assessments were undertaken. Random effects meta-analyses were conducted for the two primary review outcomes (TB recurrence or relapse and mortality during treatment), and heterogeneity was explored using subgroups. Other outcomes were synthesized narratively. Our searches identified 1,249 records, of which 28 were included in the meta-analyses. Based on 15 studies, higher risk of TB recurrence or relapse was found with ever using tobacco vsnever using tobacco (risk ratio [RR], 1.78; 95%CI, 1.31-2.43; I2= 85%), current tobacco use vsno tobacco use (RR, 1.95; 95%CI, 1.59-2.40; I2= 72%), and former tobacco use vsnever using tobacco (RR, 1.84; 95%CI, 1.21-2.80; I2= 4%); heterogeneity arose from differences in study quality, design, and participant characteristics. Thirty-eight studies were identified for mortality, of which 13 reported mortality during treatment. Ever tobacco use (RR, 1.55; 95%CI, 1.32-1.81; I2= 0%) and current tobacco use (RR, 1.51; 95%CI, 1.09-2.10; I2= 87%) significantly increased the likelihood of mortality during treatment among people with TB compared with never using tobacco and not currently using tobacco, respectively; heterogeneity was explained largely by differences in study design. Almost all studies in the meta-analyses scored high or moderate on quality assessments. Narrative synthesis showed that tobacco use was a risk factor for other unfavorable TB treatment outcomes, as previously documented. Evidence on ST was limited, but identified studies suggested an increased risk for poor outcomes with its use compared with not using it. Tobacco use significantly increases the risk of TB recurrence or relapse and mortality during treatment among people with TB, highlighting the need to address tobacco use to improve TB outcomes. PROSPERO; No.: CRD42017060821; URL: https://www.crd.york.ac.uk/prospero/.

PRELIMINARY RESULTS FROM GLASGOW INTERNATIONAL RADIOCARBON INTERCOMPARISON

ABSTRACT GIRI (Glasgow International Radiocarbon Intercomparison) was designed to meet a number of objectives, including to provide an independent assessment of the analytical quality of the laboratory/measurement and an opportunity for a laboratory to participate and improve (if needed). The principles in the design of GIRI were to provide the following: (a) a series of unrelated individual samples, spanning the dating age range, (b) linked samples to earlier intercomparisons to allow traceability, (c) known age samples, to allow independent accuracy checks, (d) a small number of duplicates, to allow independent estimation of laboratory uncertainty, and (e) two categories of samples—bulk and individual—to support laboratory investigation of variability. All of the GIRI samples are natural (wood, peat, and grain), some are known age, and overall their age spans approx. &gt;40,000 years BP to modern. The complete list of sample materials includes humic acid, whalebone, grain, single ring dendro-dated samples, dendro-dated wood samples spanning a number of rings (e.g., 10 rings), background and near background samples of bone and wood. We present an overview of the results received and preliminary consensus values for the samples supporting a more in-depth evaluation of laboratory performance and variability.

Rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis: a systematic review and meta-analysis

ObjectiveThe first biomarker associated with the rheumatoid arthritis is rheumatoid factor (RF) and since the earliest reports a role has been proposed in the diagnosis and in the prediction of...